低相对分子质量肝素抗凝时高岭土-血栓弹力图R时间目标值研究

目的 探讨低相对分子质量肝素（low molecular weight heparin,LMWH）抗凝时,高岭土-血栓弹力图R时间目标值.方法 测定不同浓度LMWH抗凝时血液aPTT和R时间,检测94例（131例次）LMWH抗凝患者的高岭土-血栓弹力图R时间和肝素酶-血栓弹力图△R％,比较R时间和△R％判断抗凝效果是否一致.结果 aPTT和R时间均与LMWH浓度（在0～2.0抗Xa u/ml范围）呈正直线相关（P＜0.01）.aPTT为正常值2倍时,LMWH浓度为0.55 ～1.32抗Xa u/ml.抗Xa活性在此范围内的R时间为10.2～16.8 min.131例次LMWH抗凝患者R时间为8.14±5.97min,肝素酶-血栓弹力图△R％为9.06 ±25.26％；R时间和肝素酶△R％判断LMWH抗凝效果符合率为87.8％,两种方法判断效果基本一致（Kappa=0.61,P＜0.001）.结论 LMWH治疗血栓性疾病时,高岭土-血栓弹力图R时间目标值为10.2～ 16.8 min（正常值5～ 10 min）.

The Target Value of Kaolin-thromboelastography R Time for Anticoagulation Therapy with Low Molecular Weight Heparin

Objective To explore the target value of kaolin-thromboelastography R time for anticoagulation therapy with low molecular weight heparin （LMWH）.Methods Activated partial thromboplastin time （aPTT） and kaolin-thromboelastography R time were detected when different concentrations of LMWH was added to venous blood.131 occasions of kaolin-thromboelastography and heparinase-modified thromboelastography were conducted in 94 patients treated with LMWH.The consistence rate for evaluating the anticoagulation effect of LMWH with R time and heparinase-modified thromboelastography △ R ％ was compared.Results Both aPTT and R time showed positive linear correlation with the concentration of LMWH （within 0 ～ 2.0anti-Xa u/ml,P ＜0.01）.When aPTT was 2 times normal value,the concentration of LMWH was 0.55 ～ 1.32 anti-Xa u/ml.At this anti-Xa range,the R time was 10.2 ～ 16.8 min.In 94 patients （131 times） treated with LMWH,R time was 8.14 ± 5.97 min,and △ R ％ was 9.06 ± 25.26 ％.A high degree of consistency was seen when R time and △ R ％ were used to evaluate the anticoagulation effect of LMWH,with consistence rate being 87.8 ％ （Agreement kappa =0.61,P ＜ 0.001）.Conclusion In anticoagulant therapy with LMWH,the target value of kaolin-thromboelastography R time was 10.2 ～16.8 min （Normal R time is 5 ～10min）.